Shoulder Pain 6 Months After Labrum Surgery – Cause and What to Do
Pain 6 months after shoulder surgery is FRUSTRATING! When you’re going into an arthroscopic surgery, it is important to have realistic expectations about the process. Some amount of pain and stiffness immediately after the procedure is normal. However, if you are still experiencing shoulder pain after 4 to 6 months, your surgery may not have been a success, and further treatment maybe needed.
Flickr Image by Marco Verch Professional Photographer
What is Failed Shoulder Surgery?
Failed shoulder surgery refers to a lack of recovery after the operation. This can include shoulder instability, chronic pain, weakness, or limited mobility. Other symptoms may consist of shoulder stiffness or a cracking sound when you move your arm.
If the shoulder surgery did not have the intended effect after proper postoperative care and regular physical therapy, the surgery failed because of some underlying cause.
5 Reasons Why Shoulder Surgery Fails
There are many reasons for failed shoulder surgery, and the specifics vary on a case-by-case basis. While your surgeon is the best person to help you figure out the cause, the following are a few factors that may have contributed to surgical failure.
1. Scar Tissue and Stiffness
Frozen shoulder is a common side effect of this surgical procedure. Irritation and inflammation in the operated area result in scar tissue build-up around the shoulder joint. This can limit the patient’s range of motion and cause chronic pain.
If caught early enough, the surgeon can treat this issue by putting the patient under anesthesia and physically manipulating their shoulder. Pushing those stiff muscles can help the shoulder regain mobility and flexibility. However, revision surgery is the only solution if the shoulder is left too long and excess scar tissue builds up.
2. Postoperative Infection
The reason surgeons prefer arthroscopic surgery to open surgery is that it has a very low risk of infection, less than 1 percent. Among the different types of arthroscopic shoulder surgery, rotator cuff repair has the highest risk of infection, while Bankart repair has the lowest. Either way the risk is very low.
In a total shoulder replacement, an infection can develop at the joint, where the artificial ball and socket implants are susceptible to bacteria. Additionally, the location of the infection means antibiotics cannot treat it. Some symptoms of postoperative infection include pain, redness, swelling, secretion, and in severe cases, fever.
To treat an infected shoulder joint, a surgeon may:
- wash out the area and treat the inflammation
- replace the implants as part of a complete revision surgery
Depending on the severity of the infection, revision surgery may take place in two steps. In the first stage, the wound is cleaned out, and a cement block full of antibiotics or a spacer is placed within the shoulder. After a week or two, the spacer is removed, and a new prosthetic joint is installed.
3. Rotator Cuff Repair Failure
Rotator cuff repairs have the highest potential for failure and can be identified through symptoms like shoulder pain, weakness, and stiffness. This type of failure is difficult to identify because torn tendons post operatively may not be accurately diagnosed using an MRI. However, after three months, an arthrogram-MRI may be used to determine the degree of tear.
Realistically, rotator cuff surgery does not guarantee complete recovery. In some patients, the tendons heal partially. In others, they heal completely, and in an unlucky few, they do not heal at all. Therefore, a second surgery may be necessary. However, revision rotator cuff repair does not have a high success rate. So the doctor may recommend conservative treatment options for pain management depending on your condition.
4. Lack of Physical Therapy After Surgery
Research shows that failure during rehabilitation is a primary cause of surgical failure. Therefore, patients need to make major life changes after surgery and commit to several months of rest and rehabilitation for a complete recovery.
That means a leave of absence from work, especially if it is a strenuous job in a labor-oriented or athletic field. Regular physical therapy is necessary to prevent scar tissue from developing and gradually increase strength and range of motion.
Flickr Image by Marco Verch Professional Photographer
Without a significant amount of home exercise or physical therapy, the body will not be able to recover from the shoulder injury. However, if these steps are not taken and the shoulder is stressed, it may result in a failed surgery.
Ideally, patients need around 3 to 6 months of physical therapy after surgery. At first, the sessions should be more regular, 2 times a week. Eventually, these can reduce to 2 to 4 times per month.
5. Bad Reaction to Implants
Although extremely uncommon, metal allergy can cause implant failure after rotator cuff repairs. A bad reaction to implants can result in pain and stiffness that lasts several months. Typically the anchors used today are not metal. This makes reactions very rare.
Once the problem is identified, your orthopedic surgeon can search for alternative solutions.
6. Nerve Injury and Weakness
Studies show that nerve injury is a rare but potential risk for shoulder arthroscopy. That is because the suprascapular, axillary, and musculocutaneous nerves all lie within 3 cm of the operated area. The risk of nerve injury varies depending on the type of shoulder operation. The rate of damage in patients is 1 to 2 percent for rotator cuff repair, 1 to 8 percent for anterior instability, and 1 to 4 percent for prosthetic arthroplasty.
Nerve injury may require immediate treatment and can only be diagnosed through postoperative observation. If this is the reason for your failed shoulder surgery, you may need a second surgery, or it may just take time for the nerve to recover. It is best to get a thorough physical examination.
7. Unhealed Fracture
One problem specific to reverse and anatomic total shoulder replacement is a bone fracture around the implant. Also known as periprosthetic fracture, this break occurs during the surgery while the surgeon places the implant. Additionally, baseplate failure may occur if the bone doesn’t grow around the socket component of the implant.
A concerned doctor will keep the patient under observation if they think there is a risk of unhealed fractures. Alternatively, if you are experiencing pain, stiffness, several months after the surgery, then X-ray and MRI testing will let your doctor identify the problem.
What Are Treatment Options for A Failed Surgery?
Depending on the severity and cause of the failure, you may need surgical or non-surgical intervention. A conservative treatment option may include pain medicine, corticosteroid injections, or a physical therapy program to stretch and strengthen the muscles and ligaments in the affected shoulder.
If these are unsuccessful, your doctor may recommend surgical treatment to resolve the issue. Revision surgery can be used to repair fractures or tears, tighten loose implants, increase shoulder stabilization, and take other necessary steps to fix the problem. Failed rotator cuff repair will need to be re-repaired while non-healing fractures will require additional fixation.
Final Thoughts
Overall, shoulder surgery is very successful. However, there is no guarantee that shoulder surgery will fix all your problems. In many cases, patients continue experiencing some level of pain, stiffness, mobility restrictions, and weakness. Surgery failure can occur because of a host of reasons, and your doctor will help you explore treatment options based on your individual case.